Healthcare Provider Details

I. General information

NPI: 1053411686
Provider Name (Legal Business Name): STACY DENISE COWARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 STILLMEADOW CT
VIRGINIA BEACH VA
23456-4940
US

IV. Provider business mailing address

1924 STILLMEADOW CT
VIRGINIA BEACH VA
23456-4940
US

V. Phone/Fax

Practice location:
  • Phone: 321-287-4927
  • Fax:
Mailing address:
  • Phone: 321-287-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9231733
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1169953
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: